What Degree(s) Do You Need to Become a Chief Nursing Officer?

The chief nursing officer (CNO) (also known as head nurse, director of nursing, or vice-president of nursing) is responsible for running a healthcare facility’s nursing department. Though they rarely make clinical rounds, chief nursing officers have a tremendous impact on the quality of patient care. They manage the entire nursing staff and represent nurses’ interests before the executive board, fighting for better practices and resources.

In this article on chief nursing officer education, we will cover:

• Chief nursing officer job description
• Career path to become a chief nursing officer
• Graduate education to become a chief nursing officer
• Certifications for chief nursing officers

Chief nursing officer job description

As a chief nursing officer, you are the straw that stirs the drink. When things go smoothly, nobody knows that you’re there. When things go badly (say, when somebody comes in with a straw up their nose and doesn’t receive adequate care), you are the one that needs to answer the tough questions and make changes.

Even though they probably won’t interact with patients daily, the CNO might be the most important nurse in the building. An article in the Columbia Nursing Magazine outlines the importance of having a good chief nursing officer. In the piece, Kevin Browne (deputy CNO for Memorial Sloan Kettering Cancer Center), describes the CNO as “the one nurse at the helm of nursing services.” He adds that the CNO is the administrator who “is required to maintain clinical and patient-care standards,” “ensures that patients [receive] safe, accurate, high-quality care,” and “sees that dollars are there to support the resources needed.”

CNOs are well-compensated for their hard work. The median salary for chief nursing officers hovers around $127,000 per year, and those in the 90th percentile earn over $200,000 (these CNOs typically work for major hospitals). Their income is similar to some other healthcare executive board members’ (according to Indeed, hospital chief compliance officers earn about $130,000 annually) and lower than others’ (Salary.com reports that a chief medical officer earns a little over $400,000 per year).

Career path to becoming a chief nursing officer

Getting hired as a CNO typically requires many years of nursing and management experience. Most CNOs work their way up the nursing ranks by starting out as registered nurses (RN), which usually means earning a Bachelor of Science in Nursing (BSN). All registered nurses must earn initial licensure by passing the NCLEX-RN exam. There may be additional requirements for the state in which you wish to practice.

You can become an RN with just an Associate Degree in Nursing (ADN), a two-year degree offered at many community colleges. It is cheaper than the four-year BSN but does not open the door to as many graduate education opportunities. Most employers and continuing education programs prefer candidates with a BSN. If you already hold an ADN, you can upgrade your degree through an RN to BSN or RN to Master of Science in Nursing (MSN) program.

Setting yourself up for advanced education is important because most CNOs become either nurse practitioners or another type of advanced practice registered nurse. These careers require a master’s in nursing and often involve choosing a practice specialty.

After advancing your career in clinical nursing, you will likely need to shift to nursing administration. Since a large part of the CNO job description involves managing a team to implement patient-centered care and better business practices, it is helpful—even a requirement in many job listings—to have mid-level nursing management experience. Working as a charge nurse (an RN with administrative responsibilities) is a good way to earn this essential experience.

The path you take to become a CNO is ultimately irrelevant, as long as you gain the proper skills and experience along the way. Some current CNOs chose to continue their education even further by earning a Doctor of Education in Nursing and becoming nursing professors. There is no single “right way” to reach the top of the nursing world.

Graduate education to become a chief nursing officer

While it is not impossible for an RN to become the head nurse, most have graduate degrees in their chosen specialty.

The fact that there is no single path to becoming a head nurse is a double-edged sword. It means you have room to study options that interest you and create a unique resume, but also that you cannot merely check boxes and expect to be a CNO.

Some of the most common graduate degrees for head nurses include:

• Doctor of Nursing Practice (DNP)
• Master of Science in Nursing (MSN)
• Master of Health Administration (MSHA)
• Doctor of Philosophy in Nursing (PhD)

Doctor of Nursing Practice

Most doctoral degrees prepare candidates for teaching positions. Earning a DNP, however, “prepares nurse clinicians (RNs) or advanced practice nurses (APRNs) to provide fully accountable and comprehensive care to patients,” according to Columbia University.

DNP programs take three to four years to complete and prepare students for a career as an advanced practice registered nurse (APRN) with specialties like:

• Nursing midwife: Focuses on providing healthcare services to women, including gynecological exams, family planning services, prenatal care, labor and delivery support, and neonatal care. Nurse Midwives play a crucial role in health counseling and education for women, from adolescence through menopause, emphasizing holistic and preventive health measures.
• Adult gerontology nurse practitioner: Specializes in the comprehensive care of adults across the lifespan, from adolescence through old age. This specialty emphasizes the prevention, diagnosis, and management of common and complex health conditions in older adults, including chronic illness management, health promotion, and disease prevention strategies to enhance the quality of life for aging populations.
• Nurse anesthetist: Focuses on providing anesthesia and anesthesia-related care to patients before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures. Nurse Anesthetists are advanced practice nurses who work collaboratively with healthcare teams to ensure the safe administration of anesthesia, pain management, and provide care in a variety of settings including hospitals, outpatient surgery centers, and physicians’ offices.

You can start DNP a program with just a bachelor’s degree or even just an RN certification. It’s not like a PhD program that requires years and years of education beforehand. The qualities DNP programs look for are mostly experiential.

Schools with well-known programs include:

• Boston College
• University of California – Los Angeles
• University of Pittsburgh Medical Center – Shadyside School of Nursing
• University of Virginia (Main Campus)
• Yale University

Master of Science in Nursing

Like the DNP, an MSN is designed specifically for working nurses. The degree generally takes between two and three years to earn. MSN programs prepare students to be nurse practitioners and other advanced practice registered nurses; it leads to careers in such fields as:

• Clinical nurse specialist: A Clinical Nurse Specialist (CNS) is an advanced practice registered nurse (APRN) who focuses on improving patient outcomes and nursing care within a specific specialty area, such as pediatrics, geriatrics, oncology, or psychiatric care. CNSs provide diagnosis, treatment, and ongoing management of patients, while also implementing evidence-based practice, conducting research, and serving as a consultant to nursing staff and management.
• Family nurse practitioner: A Family Nurse Practitioner (FNP) is an APRN who provides comprehensive healthcare services to individuals and families across all ages, genders, diseases, and body systems. FNPs conduct physical exams, diagnose and treat common illnesses and injuries, prescribe medications, and manage chronic diseases. They emphasize health promotion, disease prevention, and patient education in their practice.
• Emergency nurse practitioner: An Emergency Nurse Practitioner (ENP) specializes in emergency care, providing rapid assessment and treatment of patients with acute illnesses or injuries that require immediate medical attention. ENPs work in emergency departments, urgent care centers, and trauma centers, where they perform procedures, order and interpret diagnostic tests, and manage emergency health conditions.
• Geriatric nurse practitioner: A Geriatric Nurse Practitioner (GNP) specializes in the healthcare of elderly patients, focusing on the prevention, diagnosis, and treatment of conditions common in older adults. GNPs address the unique health care needs of the aging population, including chronic diseases, mobility issues, mental health, medication management, and end-of-life care.
• Nurse administrator: A Nurse Administrator is a nursing professional who focuses on the management and administration of nursing services. They are responsible for staffing, budgeting, policy development, and ensuring the delivery of high-quality patient care. Nurse Administrators work in various healthcare settings, including hospitals, nursing homes, and healthcare organizations, where they also play a key role in strategic planning and leadership.

The benefit of specialized careers (in addition to receiving a raise) is that they offer more responsibility and autonomy. You can prove your leadership abilities to both your employer and fellow nurses, an essential qualification for CNOs.

Additionally, an MSN degree will prepare you to step into a role as a nursing administrator, which involves many of the same budgetary and managerial duties as a head nurse.

Schools that offer MSN degrees include:

• Ball State University
• George Washington University
• Marquette University
• University of Michigan – Ann Arbor
• Vanderbilt University

Master of Health Administration

The Master of Health Administration (MHA) degree focuses more on the business side of things than on actual nursing. It prepares students (from all types of backgrounds) for healthcare leadership roles.

There are a number of other business-focused degrees that can prepare students for the CNO role. They include:

• Master of Science in Nursing and Healthcare Leadership
• Combined MSN/MBA

It is possible to become a CNO without attending a graduate program that focuses strictly on nursing. Sometimes having a management degree (or even post-graduate certificate) could set you apart. It is not unheard of for nurses to earn MBAs on their way to leadership positions.

Schools with business-focused nursing programs include:

• Duke University
• Johns Hopkins University
• New York University
• Pennsylvania State University (Main Campus)
• University at Buffalo

Doctor of Philosophy in Nursing

Unlike the DNP, a Doctor of Philosophy (PhD) in Nursing prepares students mostly for a career in research or academia. Graduates can also become the vice-president of a hospital or continue a career in nursing.

Many programs admit only nurses who have already earned a graduate degree (either an MSN or DNP), but some are open to bachelor’s degree-holders. Some programs are offered both in-person and online, since gaining experience on clinical rotations is not the goal. The length of a PhD in nursing program depends on the amount of education that you arrive with and whether you study full- or part-time. In general, the degree takes between three and six years to complete.

Some careers open to those with a nursing PhD include:

• Professor: A Professor is a senior academic instructor who teaches students in colleges, universities, or higher education institutions. They engage in lecturing, curriculum development, mentoring students, and conducting original research in their field of expertise. Professors are also involved in publishing scholarly articles, serving on academic committees, and contributing to their academic community.
• Healthcare Leadership: This career path involves individuals in senior management and executive roles within healthcare organizations, such as hospitals, clinics, and other medical facilities. Healthcare leaders are responsible for strategic planning, overseeing operations, ensuring quality patient care, managing budgets, and leading healthcare reform initiatives. They work to improve the efficiency and effectiveness of healthcare delivery.
• Nurse Scientist: A Nurse Scientist is a registered nurse (RN) with advanced education who conducts scientific research on various aspects of health, illness, and healthcare. By generating new knowledge through research, nurse scientists aim to improve patient outcomes, develop better healthcare practices, and contribute to the science of nursing. They may work in academic settings, healthcare institutions, or research organizations.
• Nurse Researcher: Similar to a Nurse Scientist, a Nurse Researcher is focused on conducting empirical research related to nursing and healthcare. They design and implement studies, analyze data, and disseminate findings with the goal of enhancing nursing practice, patient care, and healthcare policies. Nurse Researchers often collaborate with other healthcare professionals to address critical health issues.
• Director of Clinical Performance Lab: This role involves overseeing the operations of clinical simulation labs in educational or healthcare institutions. The Director of Clinical Performance Lab is responsible for managing lab resources, coordinating simulation activities, ensuring the quality of training programs, and integrating best practices in clinical education. They play a crucial role in preparing healthcare students for real-world clinical environments through simulated learning experiences.

A nurse with a PhD can undoubtedly become a CNO, even if it isn’t the most common end result.

Some colleges and universities with nursing PhD programs include:

• Georgia State University
• University of Kentucky
• University of North Carolina at Chapel Hill
• University of Oklahoma – Health Sciences Center
• Washington State University

Certifications for chief nursing officers

Aspiring CNOs might earn any number of specialty certifications, though most apply to clinical positions. For instance, emergency nurse practitioners take the ENP exam.

Once again, your specialty doesn’t really matter. It’s more important to prove that you specialize in something. If you want to be the CNO of a children’s hospital, then you might want to look into being a pediatric nurse practitioner. Even then, it’s not a requirement.

What many head nurses do have are executive administration-specific certifications. Being certified is not necessary, but it is an excellent way to supplement a graduate degree (in fact, most certifications require a graduate degree to be eligible).

Some of examples of specialty leadership certifications include:

• Nursing executive certification (NE-BC)
• Nursing Executive, Advanced Certification (NEA-BC)
• Certified Director of Nursing Exam (CDONA)
• Certified Executive in Nursing Practice (CENP)
• Certified Medical Practicum Exam (CMPE)

Perhaps the most popular of all these is the NEA-BC, which “provides a valid and reliable assessment of the entry-level clinical knowledge and skills of the nurse charged with the managing the daily operations of a unit or service line.”

Aspiring CNOs should also consider joining a professional organization. Memberships not only demonstrate dedication to the craft but also provide networking and continuing education opportunities.

Major organizations include:

• Fellow of American Academy of Nursing (FAAN)
• Fellow of the American College of Healthcare Executives (FACHE)

Chief nursing officers don’t just have an impact on the nurses and patients under jurisdiction; the changes they make can have an effect on the medical industry as a whole. “CNOs know what needs to occur not only in terms of business and finance but also, and most importantly, in developing models of care that are going to drive desired outcomes,” says Kerri Scanlon, CNO for North Shore University Hospital, in the Columbia Nursing Magazine article. “To me, that’s the greatest indicator of exceptional nursing.”

(Last Updated on February 26, 2024)

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